Effectiveness of exercise for osteoarthritis of the knee:A review of the literature

Osteoarthritis(OA)of the knee is the most common type of arthritis and the major cause of chronic musculoskeletal pain and mobility disability in the elderly.The objective of this paper is to discuss the effectiveness of exercise for OA of the knee based on a review of the literature.We reviewed the relevant literature,i.e.systematic reviews and meta-analyses searched using PubMed.Muscle strengthening and aerobic exercises are effective in reducing pain and improving physical function in patients with mild to moderate OA of the knee.

Analysis of stress fractures in athletes based on our clinical experience

AIM:To analyze stress fractures in athletes based on experience from our sports medicine clinic.METHODS:We investigated the association between stress fractures and age,sex,sports level,sports activity,and skeletal site in athletes seen at our sports medicine clinic between September 1991 and April 2009.Stress fractures of the pars interarticularis were excluded from this analysis.RESULTS:During this period(18 years and 8 mo),14276 patients(9215 males and 5061 females)consulted our clinic because of sports-related injuries,and 263 patients(1.8%)[171 males(1.9%)and 92 females(1.8%)]sustained stress fractures.The average age of the patients with stress fractures was 20.2 years(range 10-46 years);112 patients(42.6%)were 15-19 years of age and 90(34.2%)were 20-24 years of age.Altogether,90 patients(34.2%)were active at a high recreational level and 173(65.8%)at a competitive level.The highest proportion of stress fractures was seen in basketball athletes(21.3%),followed by baseball(13.7%),track and field(11.4%),rowing(9.5%),soccer(8.4%),aerobics(5.3%),and classical ballet(4.9%).The most common sites of stress fractures in these patients were the tibia(44.1%),followed by the rib(14.1%),metatarsal bone(12.9%),ulnar olecranon(8.7%)and pelvis(8.4%).The sites of the stress fractures varied from sport to sport.The ulnar olecranon was the most common stress fracture site in baseball players,and the rib was the most common in rowers.Basketball and classical ballet athletes predominantly sustained stress fractures of the tibia and metatarsal bone.Track and field and soccer athletes predominantly sustained stress fractures of the tibia and pubic bone.Aerobics athletes predominantly sustained stress fractures of the tibia.Middle and long distance female runners who sustained multiple stress fractures had the female athlete triad.CONCLUSION:The results of this analysis showed that stress fractures were seen in high-level young athletes,with similar proportions for males and females,and that particular sports were associated with specific sites for stress fractures.Middle and long distance female runners who suffered from multiple stress fractures had the female athlete triad.

Laparoscopic right hemicolectomy for ascending colon cancer with persistent mesocolon

Persistent ascending or descending mesocolon is an embryological anomaly that occurs during the final process of intestinal development in organogenesis.Specifically,the primitive dorsal mesocolon fails to fuse with the parietal peritoneum in the fifth month of gestation.Herein,we describe a case of ascending colon cancer with persistent ascending and descending mesocolon treated by laparoscopic right hemicolectomy.Preoperative computed tomography imaging of the abdomen demonstrated that the descending colon shifted at the midline of the abdomen and the sigmoid colon was located under the ascending colon.The detailed preoperative imaging examination revealed malpositioning of the large intestine and aided in the procedural planning.Because persistent mesocolon may result in the formation of abnormal adhesions,an accurate preoperative diagnosis is essential.We propose that it is important to consider this anomaly when making the preoperative imaging diagnosis to ensure a safe operation.

Curvature derived from LiDAR digital elevation models as simple indicators of debris-flow susceptibility

To mitigate the damage caused by debris flows resulting from heavy precipitation and to aid in evacuation plan preparation, areas at risk should be mapped on a scale appropriate for affected individuals and communities. We tested the effectiveness of simply identifying debris-flow hazards through automated derivation of surface curvatures using LiDAR digital elevation models. We achieved useful correspondence between plan curvatures and areas of existing debris-flow damage in two localities in Japan using the analysis of digital elevation models(DEMs). We found that plan curvatures derived from 10 m DEMs may be useful to indicate areas that are susceptible to debris flow in mountainous areas. In residential areas located on gentle sloping debris flow fans, the greatest damage to houses was found to be located in the elongated depressions that are connected to mountain stream valleys. Plan curvaturederived from 5 m DEM was the most sensitive indicators for susceptibility to debris flows.

Strategy for prevention of hip fractures in patients with Parkinson's disease

Hypovitaminosis D and K due to malnutrition or sunlight deprivation,increased bone resorption due to immobilization,low bone mineral density(BMD)and an increased risk of falls may contribute to an increased risk of hip fractures in patients with Parkinson’s disease.The purpose of the present study was to clarify the efficacy of interventions intended to prevent hip fractures in elderly patients with Parkinson’s disease.Pub Med was used to search the literature for randomized controlled trials(RCTs)regarding Parkinson’s disease and hip fractures.The inclusion criteria were 50 or more subjects per group and a study period of 1 year or longer.Five RCTs were identified and the relative risk and95%confidence interval were calculated for individual RCTs.Sunlight exposure increased serum hydroxyvitamin D[25(OH)D]concentration,improved motor function,decreased bone resorption and increased BMD.Alendronate or risedronate with vitamin D supplementation increased serum 25(OH)D concentration,strongly decreased bone resorption and increased BMD.Menatetrenone(vitamin K2)decreased serum undercarboxylated osteocalcin concentration,decreased bone resorption and increased BMD.Sunlight exposure(men and women),menatetrenone(women),alendronate and risedronate with vitamin D supplementation(women)significantly reduced the incidence of hip fractures.The respective RRs(95%confidence intervals)according to the intention-to-treat analysis were 0.27(0.08,0.96),0.13(0.02,0.97),0.29(0.10,0.85)and 0.20(0.06,0.68).Interventions,including sunlight exposure,menatetrenone and oral bisphosphonates with vitamin D supplementation,have a protective effect against hip fractures elderly patients with Parkinson’s disease.

Effect of risedronate on speed of sound in postmenopausal women with osteoporosis

AIM: To examine the effects of treatment with risedronate for 1 year on speed of sound(SOS) of the calcaneus and bone turnover markers in postmenopausal women with osteoporosis. METHODS: Thirty-eight postmenopausal women with osteoporosis who had been treated with risedronate for > 1 year were enrolled in the study. The SOS and bone turnover markers were monitored during treatment with risedronate for 1 year. RESULTS: The urinary levels of cross-linked N-terminal telopeptides of type Ⅰ collagen and serum levels of alkaline phosphatase were significantly decreased at 3 mo(-34.7%) and 12 mo(-21.2%), respectively, compared with the baseline values. The SOS increased modestly, but significantly by 0.65% at 12 mo compared with the baseline value. Treatment with risedronate elicited an increase in the SOS of the calcaneus exceeding the coefficient of variation in vivo(0.27%). CONCLUSION: The present study confirmed that risedronate suppressed bone turnover and elicited a clinically significant increase in the SOS of the calcaneus in postmenopausal women with osteoporosis.

Return to sports activity by athletes after treatment of spondylolysis

AIM:To clarify the efficacy of conservative and surgical treatment of spondylolysis in athletes.METHODS:PubMed was used to perform a search of the literature for studies published during the period from 1990 to 2009 that reported data on the outcome of conservative or surgical treatment of spondylolysis in athletes.The articles were examined for data on the percentage of athletes who returned to sports activities and the interval between the start of treatment and their return.RESULTS:Five studies were identified.Two studies were concerned with conservative treatment and the other three with surgical treatment(wire fixation or screw fixation with bone graft).The percentages of athletes who returned to sports activities ranged from 80.0%to 89.3%and from 81.9%to 100%,respectively,and the intervals until their return ranged from 5.4 to 5.5 mo and from 7 to 12 mo,respectively.CONCLUSION:The percentages of athletes who returned to sports activities after conservative and surgical treatment appeared to be satisfactory,but the

S(+)-Flurbiprofen Shows Potent PGE2 Inhibitory Activity in Inflammatory Cells, Superior Cell Transport Activity and Skin Permeability

We developed a novel topical non-steroidal anti-inflammatory drug (NSAID)patch, S(+)-flurbiprofen plaster, (SFPP), containing S(+)-flurbiprofen (SFP), an enantiomer of flurbiprofen (FP). In a previous study conducted in an animal model, we showed good skin absorption and potent analgesic efficacy of SFPP. In this study, to examine the superior features, as an NSAID patch, of SFP as compared to FP and R(-)-flurbiprofen (RFP), we tested the stereospecificity of SFP actions on Prostaglandin E2 (PGE2) inhibition in rat inflammatory leukocytes and in the binding activity of the drug to cells, and also the in vitro skin permeability of the drug in the Yucatan micropig (YMP). SFP showed potent inhibitory activity on PGE2 production from peritoneal leukocytes stimulated with a bacterial suspension, as compared to RFP and FP. The half maximal (50%) inhibitory concentration (IC50) values were 14 nM for SFP, 52 nM for FP, and 17,000 nM for RFP. In the cell binding study, significant and rapid increase of SFP binding to polymorphonuclear leucocytes (PMNs) was observed at 5 min after incubation, eventually reaching a steady state. SFP showed significantly higher binding activity for the inflammatory leucocytes as compared to RFP, suggesting its superior transfer potency. The skin permeability profile of SFP, RFP and FP in the YMP model showed that the rank order of the cumulative amount of permeated compounds in the skin was SFP > RFP > FP. The steady-state permeation rate (Flux) of SFP was significantly higher than that of FP (4.89 and 1.55 mg/cm2/h, respectively, p = 0.0068), indicating the remarkably superior skin permeability of SFP. SFP exerted potent inhibitory activity on PGE2 production and superior binding activity to the PMNs and skin permeability, as compared to FP and RFP. These results suggest that SFP possesses favorable characteristics for use as an active ingredient in the NSAID patch.